Provider Demographics
NPI:1366554974
Name:SMITH, MICHAEL DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 VOLUNTEER PKWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-6701
Mailing Address - Country:US
Mailing Address - Phone:423-217-1700
Mailing Address - Fax:423-217-1717
Practice Address - Street 1:2319 VOLUNTEER PKWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-6701
Practice Address - Country:US
Practice Address - Phone:423-217-1700
Practice Address - Fax:423-217-1717
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518181Medicaid
TN1518181Medicaid
TN103G354630Medicare PIN